Inspection on 03/01/07 for 31 Carter Avenue

This inspection was carried out on 3rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

31 Carter Avenue 25/06/08

31 Carter Avenue 12/01/06

31 Carter Avenue 26/07/05

31 Carter Avenue 01/03/05

31 Carter Avenue 15/07/04

31 Carter Avenue 10/02/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Carter Avenue, 31 31 Carter Avenue Shankin Isle Of Wight PO37 7LG Lead Inspector Janet Ktomi Unannounced Inspection 3rd January 2007 12.30 Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carter Avenue, 31 Address 31 Carter Avenue Shankin Isle Of Wight PO37 7LG 01983 867845 01983 865777 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Islecare `97 Limited Mr Christopher Geoffrey Stewart Hyland Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user may be accommodated in Category LD(E) Date of last inspection 12th January 2006 Brief Description of the Service: 31 Carter Avenue is a home that provides personal care and accommodation for 6 younger adults with a learning disability. The home is a detached 2 storey property situated in a residential area of Shanklin within walking distance of local shops, and town centre with its amenities and leisure facilities. There is a good-sized garden to the rear, which is available for residents’ use. Parking is limited to the road in Carter Avenue and level access is via the front of the premises. There is no lift to the first floor and residents on that level are fully ambulant. The registered providers are Islecare 97 Ltd. The homes registered manager is Mr Christopher Hyland. The manager was unable to provide information about individual fees. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first ‘Key Inspection’ for 31 Carter Avenue, a ‘Key Inspection’ being part of the new inspection programme, which measures the service against the key National Minimum Standards. The visit to the site of the home, was conducted by one inspector over one day lasting a total of six hours, where in addition to any paperwork that required reviewing the inspector met with all service users and staff and undertook a tour of the premises. The inspection process also involved pre fieldwork visit activity, with the inspector gathering information from a variety of professional sources, the Commission’s database, pre-inspection information provided by the service and linking with previous inspectors who have visited the home. 31 Carter Avenue provides a homely environment on a domestic scale for up to six younger adults with learning disabilities. All current service users have lived at the home for several years. The home currently has one vacancy, however there are no plans to admit any new service users and the manager stated he will be applying to the commission to reduce the number of registered places to five. The vacant upstairs bedroom has already been converted to an office. The home has a staff team who are experienced and well trained. What the service does well: What has improved since the last inspection? Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 6 There were no requirements or recommendations made following the previous inspection undertaken in January 2006. The manager informed the inspector that there is a programme of ongoing redecoration and maintenance with quotes having been obtained for refitting the downstairs bath. The home has been double-glazed and the vacant upstairs bedroom has now been converted to an office. The office is equipped with a computer that will soon be linked to the Providers network. The provider, Islecare 97, has agreed that the manager may submit an application to reduce the homes registered numbers from six to five. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Should the service have any vacancies the manager would ensure that new service users are only admitted whose needs the home could meet and who are compatible with the people who already live at the home. EVIDENCE: The home is currently registered for up to six younger adults with learning disabilities. At the time of the inspectors visit there were five people living at the home. This has been the situation for several years and no new people have been admitted to the home during this time. The manager informed the inspector that the provider, Islecare 97, had agreed that the smaller upstairs bedroom, currently vacant could be converted to an office and that an application would be made to reduce the registered numbers from six to five people. During the inspection it was seen that this room has already been converted to an office. The home therefore had no intention of admitting any new service users. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 9 With no new residents admitted to the home recently it is difficult to ascertain how effective the home’s current guidance and/or documentation would be in determining the needs, wishes and aspirations of the new service user. However, based on the records available and observations involving the current residents group, it is possible say that people generally appear happy living at the home and that their lives seem full and to be meeting their immediate needs. The inspector discussed with the manager the actions he would take should a vacancy exist in the future. The manager was clear about the need to ensure that he obtained full information from as may sources as possible about any prospective service users. Prospective admissions would be discussed with the staff team and existing service users and if it was felt that their needs could be met then they would be invited to visit the home on a number of occasions prior to making a decision about moving in. The manager was clear that existing service users views, and reactions/interactions with prospective service users during visits, would be taken fully into consideration when a final decision is made about a new admission. The manager was aware about the homes registration categories and the level of needs the home could meet. There have been no previous concerns about the statement of purpose, service users guide or contracts. Therefore these documents were not viewed and the relevant standards not assessed. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users make decisions about their lives and are supported to take risks to enable them to live as full and independent a life as possible. The new person centered care plans should ensure that individual goals and wishes continue to be met. EVIDENCE: The inspector viewed two of the five service users care plans and discussed these with the manager and key-workers. All service users have a named key worker, some service users indicating that they were aware of whom their key worker was. Key-workers described their role that included ensuring that care plans are appropriate and reviewed. Care plans seen were comprehensive in content with individuals physical, emotional, social and medical needs identified. Guidelines were provided for staff on how these needs should be Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 11 met. Care plans were seen to be reviewed regularly. Although two of the five people who live at the home have verbal communication they were not able to confirm an understanding of the care planning process. The care plans used at the home are the same as those used by the provider in other homes including those for older people. The plans are not specific for younger adults with a learning disability and do not follow a clear person centered format. The manager showed the inspector the new care planning format that will soon be introduced into the home. This follows a person centered approach and will be introduced after staff have received training on the 15th January 2007. The newer documentation, whilst not yet implemented appears well structured and set out and is intended to reflect far more the needs and wishes of the client with regards to their life and long-term support goals. With the existing care plans and incorporated into the new person centered support plans are risk assessments for individual service users. Separate risk assessments were seen to be in place for identifiable risks around the home. The manager informed the inspector that one staff member is scheduled to attend advanced training in manual handling to enable that staff member to undertake all risk assessments in respect of manual handling. Discussions with the manager and key workers indicated that risks are assessed in order to support service users to undertake domestic and life activities by minimising the risk and not to prevent people enjoying a full life that may have some risks. The evidence indicates that service users are free to and well supported in making decisions. The inspector was able to observe people, as they went about their daily routines within the home and to gauge from these observations, that the level of freedom and/or self-direction experienced by the residents’ of the home is good. People living at the home were observed returning from day services and either heading for the lounge to relax and unwind or coming into the kitchen to interact with other service users and staff. Throughout the afternoon and evening spent at the home, the residents were observed to be interacting with the staff and to be choosing the type of activity they participated in and where in the home they spent their time. One service user was overheard requesting her key worker organise her a hair appointment for the next day as it was her home day and she wanted to have her hair cut. The key worker telephoned the hairdresser and informed the service user that an appointment had been made for 11.30 the next morning. During the inspectors visit the post was being opened and contained an appointment for a service user at the hospital. Staff stated they would be rearranging the appointment as the service user was very reluctant to get up early and would probably not be able to attend at the time stated. An afternoon appointment was to be requested. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 12 Staff and the manager also discussed how the home is a home in its truest sense, describing how people are encouraged to do what they wish, within reason, whilst in the building. Service users bedrooms were seen whilst touring the home, these indicate that people are encouraged to view the property as home. Bedrooms clearly reflected the character and interests of the person occupying the room. Service users all require support to manage their personal finances. The manager showed the inspector the records and arrangements in relation to this. The manager is the appointee for all service users, who have individual building society accounts into which benefits are paid and from which assessed contributions towards the cost of their care is taken. The records for personal money were seen and indicated that service users money is spent on personal items such as toiletries and outings. The inspector noted that service users had purchased each other presents for Christmas. The manager stated he would discuss this with service users relatives or advocacy as some service users would probably not be able to agree or disagree to the purchase of gifts for other people. The manager stated that service users spend approximately the same amount of money on each other, enjoy receiving gifts and that for some the presents purchased by the other service users are the only gifts they receive on their birthdays and at Christmas. The arrangements in respect of paying for the house car were also discussed. This is jointly leased by all service users with petrol and running costs distributed according to individual use. All service users use the car. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy a varied lifestyle with opportunities to develop skills, meet friends and enjoy existing and new interests. The service users are active members of the local community and maintain family contacts. The rights of service users are respected and their daily responsibilities acknowledged. All meals are freshly prepared, individually portioned and enjoyed by the service users. EVIDENCE: Care plans viewed included individual weekly activity plans that showed that services users attend a variety of day services throughout the week. Each service user has at least one home day on which individual activities are Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 14 undertaken where possible with their key workers. Whilst viewing financial records the inspector saw evidence of money taken to day services for various activities enjoyed there. The inspector also observed residents returning to the home from various locations, noting that transport is provided by the home providing a high level of continuity and interaction with day services by the homes staff. Care staff confirmed that service users also enjoy ad hoc activities in the community especially during the warmer months when picnics and the beach are popular. The manager and staff identified that service users opportunities to enjoy external activities are sometimes restricted due to lack of personal finances therefore free or inexpensive activities such as picnics are chosen. The staff and the manager also discussed how the home does not specifically provide extra activities at the weekends for the service users, as it is felt that after a hard week at the day centres the residents’ might prefer to rest and relax, therefore any activity undertaken at the weekend is directed by the service users. The manager informed the inspector that two service users had enjoyed a holiday on the mainland with service users from the other home managed by the manager. Service users were reported to have enjoyed their holiday. As stated earlier service users each have at least one home day per week. On this day service users are able to decide what they do with one service user requesting her key worker organise a hair appointment as she wished to get her hair cut. The hairdresser used is local to the home and it was decided that the service user and her key worker would walk to the hairdressers and have a coffee afterwards. The service user discussed the shops in the local area and where they would have coffee. The home is located within a residential area of Shanklin and is only a short walk from the amenities of the town. With the exception of one, service users are registered with a local Gp and where possible local health facilities are used. The other service user has maintained her registration with the Gp with whom she was registered with prior to her moving to the home. The home has a people carrier capable of providing transport for up to seven people. This would enable all the people who live at the home and two staff (enough to support service users) to all go out together if they so wished. Staffing levels at the home are sufficient to enable service users to go out during the evening or weekend. The manager and staff stated that extra staff could be provided if there are specific events or social activities such as often occurs through the Christmas/New Year period. On the day of the inspectors visit three staff were on duty through the afternoon. Discussions with the manager, staff and some service users indicated that the home supports service users to maintain contact with family members. The Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 15 inspector’s visit occurred soon after Christmas and care records contained information about visits to and from service users families. In discussion with the manager and care staff it was clear that they generally had good relationships with the families, and they were consulted appropriately and included in reviews. It was also apparent that the manager and his staff also understood and appreciated people’s arrangements for home visits, care staff were able to discuss when and how often people have family contact, without reference to the care plans. During the inspectors visit one service user discussed various family members and the key worker was able to give additional information as to what the various family members did for work and where they lived. Relative questionnaires were sent to the home prior to the inspection however none were returned. Menus were received with the pre-inspection questionnaire and indicated that a varied diet is provided. All meals are cooked by care staff who confirmed that they had undertaken food hygiene training. At the start of the inspection the two service users at home were observed enjoying a light lunch in the dining room with the main meal being in the evening. Service users take a packed lunch to day services. Service users were seen coming into the kitchen on their return from day services to deposit their empty lunch boxes. Service users confirmed to the inspector that they had enjoyed their evening meal. Care staff stated that service users would say if they like or dislike food. Throughout the inspection service users were observed requesting and being provided with a range of hot and cold drinks. Observations also indicate that mealtimes are social occasions, with service users and staff eating together in the dining room. Service users were seen being supported to return used items to the kitchen. People are expected to clear away their own plates or cups and return these to the kitchen. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way they prefer and their physical and emotional health needs are met. The home must ensure that health action plans are completed as far as possible and improvements in the management of medication must be made. EVIDENCE: The home operates a key worker system that provides for one to one support and monitoring of residents’ daily needs. Residents at Carter Avenue are ambulant, although a wheelchair is used to assist one person when away from the home. There is a mix of male and female staff to ensure flexibility for personal or intimate care where possible. The home has two bathrooms, one fitted with a chair hoist to support service users who would have difficulty sitting down or getting up from a general bath. Times for getting up and going to bed are flexible with staff arranging for one service user to have an afternoon appointment at the hospital as she is very reluctant to get up until late morning. Service users confirmed they could go to bed whenever they Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 17 wish. Residents’ rooms were seen to be personalised and there was evidence of service users exercising choice in the clothes they wear, fashion preferences and room decorations. As previously stated one service user wanting her hair cut had an appointment at her hairdressers arranged for her next home day. The manager confirmed, and records showed that residents receive checks from their GP, dentist, chiropody, optician and specialist health care professionals. They are registered with local health clinics and dental practices. Service users tend to attend appointments at their GP however if home visits were required these would be conducted in the privacy of their own rooms. One service user had been in hospital prior to Christmas and a staff member on duty at the time of the inspectors visit described how they had supported her including providing sleep-in staff at the hospital. Service users have health action plans, one of those seen had not been fully completed and although it is acknowledged that some information may not be available other information, such as some childhood illnesses, was detailed in a life history that had been provided by the service users mother. This service users mother has contact with the home and other information might be sought to complete the health action plan. Information about current specific health needs is included in care plans. The home must ensure that health action plans are fully completed. The arrangements in respect of medication were assessed. All medication is administered by care staff and was seen to be stored in secure conditions. All except two care staff have undertaken a BTEC in medication administration with the other staff having received in house training and been assessed as competent by the manager. The remaining staff are to do the BTEC when next available. The medication administration records were viewed. It was noted that when one service user returned from hospital the medication returned with her had not been recorded onto medication administration records as entering the home. All other medication had been recorded as entering the home on the medication administration sheets. It was also noted that medication administration records had not been fully completed with a number of gaps where it was not evident if medication had been taken by the service users. This was particularly evident for one service user who had four different medication administration sheets, some containing only one or two medications. Most medication is dispensed in blister packs. The inspector viewed the blister packs and it would appear that medication not signed for had been given. The inspector was concerned that other staff who must have noted that medication records had not been completed when they next administered and signed for medication had taken no action. One medication not in the blister packs and not signed for as administered on a number of occasions was counted. The packed stated the day it was dispensed by the pharmacy and a check of the number of tablets left in the box indicated that eleven tablets had been removed from the packet although this had been signed for on twelve occasions in the Medication administration Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 18 records. The medication administration records would therefore appear to have been signed as given when the medication had in fact not been administered. The manager was unsure why this medication had been prescribed for the service user. One service user had been prescribed a liquid medication. This had not been administered for the four days preceding the inspectors visit. A calculation of the amount dispensed and signed as given would indicate that this had run out and further supplies not obtained. The manager stated that he felt the medication had not helped the service user and that she no longer required this. This is not a decision for the manager or staff in the home and an appointment to discuss this should have been made with the service users GP. Medication must be administered as prescribed by the doctor. Medication as prescribed by the doctor must be available to service users. A record of medication entering the home must be maintained. The manager and staff must be aware of why particular medications have been prescribed in order to monitor effectiveness and potential side effects. Medication administration records must be fully recorded. It is the responsibility of all staff to report medication administration or recording errors. The manager was unaware of the medication issues and must implement a checking system to ensure that medication is appropriately managed in the home. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the home are able to make complaints that would be appropriately investigated and resolved. Service users are protected from abuse, neglect and harm. The home would respond appropriately to adult protection concerns. EVIDENCE: The pre-inspection questionnaire completed by the manager stated that no complaints have been received at the service. No complaints or concerns have been received at the Commission in respect of the service. Throughout the inspectors visit service users were seen responding verbally and non-verbally to staff, making suggestions and requests. Staff have a good understanding of service users individual communication methods and would be in a position to realise if service users were unhappy. Discussions with staff and the manager indicated that complaints from service users or their relatives would be appropriately responded to. The home has in place appropriate guidance for responding to suspicion or evidence of abuse or neglect, to ensure the safety and protection of residents. The inspector also noted a copy of the local authority adult protection policy guidance. Staff training records indicate that staff have attended adult protection training and that this is included within the company induction all Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 20 staff undertake. Staff spoken with during the inspection were very clear about the need to report all issues of concern without delay and were aware of how concerns should be reported. Service users attend a variety of external day services and some would also be able to report concerns to staff within these settings. The arrangements in respect of recruitment and service users personal finances are described elsewhere in this report but should ensure that only suitable people are employed at the home and personal money is secure. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 26, 27, 28, 29 and 30 assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a warm, generally clean, home that is suitable for their individual and collective needs. EVIDENCE: The home is located in a pleasant residential area of shanklin within walking distance of the town centre. The home is a large older property owned by the Isle of Wight council. The manager confirmed that the council undertake all the necessary checks as landlords including those on gas, electrical and water supplies. As the inspector had not visited the home for a number of years the manager showed the inspector round. There was evidence of ongoing maintenance work with the manager informing the inspector that double-glazing had been fitted since the previous inspectors visit. The inspector was able to see the new office Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 22 that has been created from an unused smaller upstairs bedroom. The downstairs bathroom was seen to require some attention as the bath surround requires replacing and the tiles require regrouting to eliminate staining from mould. The manager stated that he has already obtained the quotes for the work on the bathroom and therefore no requirement in respect of this is made. The manager having already identified the need for work and taken the necessary steps to ensure this is completed. The downstairs bath has a hoist bath seat. Although the bathroom was generally clean the underside of the bath chair was not and must be thoroughly cleaned. The rest of the home was clean and without offensive odours although a chair in the dining room required a good cleaning as food had spilt over time between the seat and the wooden frame. All service users have individual bedrooms, one on the ground floor and the remaining four bedrooms on the first floor. Bedrooms are all of a good size and were seen to contain a washbasin and all the necessary fixtures and fittings. Bedrooms had been individually decorated and were pleasant and attractive rooms containing many personal items belonging to their occupant. Bedrooms are centrally heated with radiators that can be controlled in each room. Service users stated they liked their bedrooms and can access these at any times they wish. The home has two communal rooms, a large lounge and separate dining room that could double as separate sitting room, private meeting room or for activities. Service users have free access to all communal areas of the home and were observed choosing to sit in both rooms throughout the inspection. Service users are also able to access the homes kitchen and are supported to make themselves drinks or obtain snacks as they wish. The home has suitable lockable cupboards for substances that may be hazardous to health. These were locked at the start of and throughout the inspection. Furniture and fixtures in communal rooms is domestic and of a good standard. As previously stated the home now has an office in what was previously a small upstairs bedroom. This has been appropriately equipped and has a lockable door. In addition to the bathroom already mentioned the home has upstairs a WC (containing a washbasin) and separate bathroom. The bathing and communal facilities are appropriate for the current service users. The homes laundry is situated in a small conservatory off the dining room. The scale is domestic and appropriate for the number and needs of the people who live at the home. Supplies of liquid soap, paper towels and disposable aprons and gloves were available. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 23 Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34, 35 and 36 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides appropriate numbers of suitably recruited, trained and supervised staff to support service users individual and collective needs. EVIDENCE: The manager supplied staff duty rotas with the pre-inspection questionnaire that indicated that a minimum of two and at times three care staff are on duty with one sleep-in staff at night. The manager is extra to these numbers and divides his time between 31 Carter Avenue and the other home located close by for which he is also the registered manager. Discussions with care staff and evidence in service users daily records indicates that staff are able to provide a variety of external activities for service users both individually and as a group. Care staff stated that they work well as a team and this was observed throughout the time the inspector spent at the home. Professional comments were received from one care manager who stated that: ‘there is always a Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 25 senior member of staff to confer with’ and that people are ‘satisfied with the overall care provided to the service users’. Duty rotas indicated that the homes existing staff or those employed in the other home managed by the registered manager cover any additional shifts required such as resulting from annual leave or sick leave. The provider Islecare 97 also runs its own bank of carers. The manager and duty rotas confirmed that continuity of staff is provided to service users. On the day of the inspectors visit three care staff were on duty in the afternoon two being permanent staff from the home and one working an additional shift from the other home. The manager confirmed that the provider provides an on-call system with the on-call rota seen. Care staff confirmed that management support is always available and that they felt able to contact the manager should the need arise when he was not in the home. During the inspectors unannounced visit the training and development officer for the provider visited the home to undertake some individual training and assessment for a new staff member who was undertaking his Learning Disabilities Award framework. The home employs a total of nine care staff seven of who have at least an NVQ level 2 in care. Of the remaining two care staff one is undertaking the NVQ level 2 in care and the other will be registered for the NVQ once he has completed the LDAF. The home has met and surpassed the 50 ratio recommended within the National Minimum Standards. The training officer, manager and care staff confirmed that the provider Islecare 97 provides opportunities for mandatory and service user specific training. The manager listed training undertaken by staff in the pre-inspection questionnaire and that planned for the future. Care staff were positive about the training provided by the company and stated that they felt they had the necessary skills to meet service users needs. The home has recruited three new staff members since the previous inspection. The manager described the homes recruitment procedures and records were viewed. The procedures in place and records seen would indicate that a thorough recruitment and checking process is in place that should ensure that unsuitable people are not employed at the home. The manager stated that potential staff visit the home either during their interview or, if the interview is conducted at the company head office to visit the home prior to an offer of a job being made. In this way service users are able to meet potential staff and their interactions/reactions may be gauged as part of the recruitment process. One staff member on duty had transferred to the home from another service provided by the company and stated that he had visited the home and met the service users prior to becoming a permanent member of staff. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 26 Care staff and staff files viewed indicated that all staff receive regular formal supervision in addition to indirect supervision whilst the manager is in the home. Staff were clear that they could discuss concerns with the manager and that they were aware of the company structure such that issues could be taken to senior managers in the company if they felt this was necessary. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, 41 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is both appropriately qualified and experienced to operate the home. The service users can feel confident that views are listened to and the future direction of the service takes this into consideration. The standard of record keeping in the home must be improved in relation to medication records and all service users must have as fully a completed health action plan as is possible. Infection control and medication issues must be improved in order that the health, safety and welfare of the service users is appropriately promoted and protected. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 28 EVIDENCE: The home shares its registered manager with another similar service located close by. The manager has successfully managed both homes for several years and therefore demonstrated his ability to perform these joint management roles. Information contained within previous inspection reports indicate that the manager possesses both the Registered Manager’s Award (RMA) and has also completed the National Vocational Qualification (NVQ) level 4 in Care. Evidence from the pre-inspection questionnaire and other documentation provided prior to the fieldwork visit, suggests that the manager also regularly attends additional courses, alongside his staff and other senior managers, to maintain his own skills and knowledge. The manager is supported by a senior support worker in both homes and allocates specific responsibilities to staff within the homes. The provider’s management and organisational structures support the manager. Care staff stated that the manager is approachable and supportive. Service users were observed approaching the manager throughout the inspectors visit and he is clearly well known to them. One comment card was received from a care manager and this indicated no concerns in respect to the management or running of the home. Throughout the inspectors visit service users were seen to be encouraged to give opinions and their views or wishes were respected. The evidence indicates that service users are encouraged to participate in care reviews and the development of their care plans, as well as activities/entertainment and changes within the home. The home has involved the advocacy service in the past and discussions with the manager indicated that he would be consulting advocacy to determine their views about the practise of service users personal finances being used to purchase each other gifts at Christmas and on birthdays. It was also established through contact with residents and staff that the holidays attended last summer were mutually agreed. This is further evidenced by the fact that three service users chose not to have a holiday and two went on holiday. The company undertakes a variety of quality assurance visits to the home including monthly visits by a representative of the company and specific quality audits of health and safety. Throughout the inspectors visit a number of records were viewed. These have been discussed throughout the relevant sections of this report. Overall records were well maintained and appropriately stored with the exception of one health action plan and medication records. The manager must ensure all records are fully maintained. Generally the evidence indicates that the health and safety of the service users and staff is being appropriately managed. However as previous identified a number of issues were noted in relation to the management of medication in Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 29 the home and this may adversely affect the health and safety of service users. The manager must ensure that medication is appropriately managed within the home. Overall the home was clean and appropriate measures in place to prevent the spread of infection with the exception of the underside of the bath hoist seat and a chair in the dining room. Staff had access to amply supplies of disposable aprons and gloves. There were no immediate health and safety concerns were identified with regards to the fabric of the premises during the tour of the premises. The pre-inspection questionnaire establishes that full health and safety policies/guidance documents are made available to the staff. Health and safety training is clearly made available to staff, with the dataset evidencing that staff complete first aid, fire safety, moving and handling, infection control and food hygiene. Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 3 X 3 X 2 2 X Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 31 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA19 YA41 YA20 YA41 YA42 Regulation 12 (3) 13 (2) 12 (1) (a) Requirement Health action plans must be completed as fully as possible. Medication must be administered as prescribed by the doctor. Medication as prescribed by the doctor must be available to service users. A record of medication entering the home must be maintained. Medication administration records must be fully recorded. It is the responsibility of all staff to report medication administration or recording errors. The underside of the bath hoist chair must be kept clean at all times. Timescale for action 01/03/07 20/01/07 3. YA30 YA42 23 (2) (d) 20/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 32 Carter Avenue, 31 DS0000012472.V318892.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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